Postmenopausal bleeding is bleeding from the vagina after a woman has stopped having menstrual cycles due to menopause. Because perimenopause can last several years, periods may be irregular for months. Once a woman has gone 12 months without a period, she is considered to be in menopause. Vaginal bleeding that occurs after that 12-month timeframe is considered postmenopausal bleeding.
Women with postmenopausal bleeding should always see a doctor, in order to rule out serious medical problems.
Bleeding can occur in postmenopausal women for several reasons. For example, women who take hormone replacement therapy may have vaginal bleeding for a few months after starting the hormones. It is also possible a woman who was believed to be in menopause may ovulate. If this occurs, bleeding may also occur.
Additional causes of bleeding after menopause include uterine polyps, which are non-cancerous growths in the lining of the endometrium. Another possible cause is endometrium hyperplasia, which is the thickening of the endometrium.
Bleeding may also develop due to thinning of the vaginal tissues. This is common in women who are postmenopausal. Thinning often develops due to a decrease in estrogen.
Although bleeding after menopause is often harmless, postmenopausal bleeding can be a sign of cancer. According to Harvard Health Publications, about 10 percent of women who have postmenopausal bleeding have endometrial cancer. (Harvard Health Publications)
Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present and depend on the cause of bleeding. Women that have postmenopausal bleeding due to thinning of the vaginal tissues may experience pain with intercourse.
The first step in diagnosing the cause is an exam and a medical history. A doctor may conduct a pap smear as part of a pelvic exam. This can also screen for cervical cancer.
A transvaginal ultrasound is one option. This procedure allows doctors to view the ovaries, uterus, and cervix. In this procedure, a technician inserts a probe into the vagina or asks the patient to insert it herself. The probe emits sound waves that bounce off of inner structures. A computer then creates pictures of the inner structures.
Another diagnostic procedure is a hysteroscopy. This procedure shows endometrial tissue. In a hysteroscopy, a doctor inserts a fiber optic scope into the vagina and cervix. The doctor then pumps carbon dioxide gas through the scope. This helps to expand the uterus and makes the uterus easier to see. During this procedure, a doctor may also remove polyps or take a biopsy of endometrial tissue in order to rule out cancer.
In some cases, bleeding may require no treatment. Treatment depends on the cause of the bleeding, on whether bleeding is heavy, or if additional symptoms are present. In situations where cancer has been ruled out, treatment may include the following:
- Estrogen creams: Your doctor may prescribe estrogen cream if your bleeding is due to thinning and atrophy of your vaginal tissues.
- Polyp removal: Polyp removal is a surgical procedure.
- Progestin: Progestin is a hormone replacement. Your doctor may recommend it if your endometrial tissue is overgrown. Progestin can decrease the overgrowth of tissue and reduce bleeding.
- Hysterectomy: Bleeding that cannot be treated in less invasive ways may require a hysterectomy. During a hysterectomy, your doctor will remove the patient’s uterus. The procedure may be done laparoscopically or through conventional abdominal surgery.
If bleeding is due to cancer, treatment will depend on the type of cancer and how advanced it is. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.
Postmenopausal bleeding is successfully treated in many cases. If your bleeding is due to cancer, the prognosis depends on the type of cancer and stage at which it was diagnosed. The five-year survival rate is about 95 percent when endometrial cancer is detected early and has not spread (Medline Plus).